The Melanie Avalon Biohacking Podcast Episode #181 - Dr. Heather Moday

TRANSCRIPT

Melanie Avalon: Hi friends. Welcome back to the show. I am so incredibly excited about the conversation that I am about to have. So, the backstory on this conversation, if listeners listen to my episode that I did with Bill Tancer, the founder of Signos, which is a CGM company. I actually interviewed him for his books, not so much related to CGMs, but he is absolutely amazing and he has a podcast and he's been connecting me to some guests that he's had on his show. A while ago he had interviewed Dr. Heather Moday for her book The Immunotype Breakthrough, and said that I basically just had to interview her. I was so, so excited because I had been dying to do an episode deep on the immune system. So, when I saw the title of the book, I was like, I really hope that this is what I'm hoping it is as far as being a really deep dive into everything that goes on with that.

Not only was it that-- This was like, I feel like the education that I needed about the immune system that I just had been wanting to have for so long. Not only was that fabulous and fantastic, but on top of that, it tackled something about the immune system that I personally am really interested in, which is how different people individually have different manifestations of the immune system. Heather actually has four immunotypes that she talks about. So, this book, I really recommend it to everybody. There's no way we're going to even remotely touch on everything in it, so just go buy it now. We will get into some of the nitty gritty on today's conversation. So, Heather, thank you so much for being here.

Heather Moday: It's really great to be here, Melanie. Thanks for having me.

Melanie Avalon: Of course. Thank you. To start things off, so you are an allergist and an immunologist and an integrative and functional medicine physician. You received your MD from Tulane Medical School in New Orleans and had a residency in internal medicine and a fellowship in allergy and immunology at Montefiore.

Heather Moday: Montefiore.

Melanie Avalon: Yeah, Montefiore, I knew I was going to forget [chuckles], /Albert Einstein Medical Center in New York City. You have a certification through the Institute for Functional Medicine. This is super cool that you're part of the mindbodygreen Collective. I didn't realize that they had a curated group of 50 experts that is super cool. That sounds like a very elite.

Heather Moday: I don't know if they still talk about it, but it was a few years ago. They sort of put it together.

Melanie Avalon: Yeah, that's really cool. I mean, obviously I'm very familiar with mindbodygreen and that is quite an honor. Did they reach out to you or did you get nominated? How did that work?

Heather Moday: Yeah, I'm not sure. It was about three years ago now that I think someone nominated me and I don't even know who it was. They reached out and I was on their podcast. I've been on their podcast twice, actually. Jason is just amazing. Yeah. We wrote a bunch of articles and things, and their company has evolved over the past four years, so things might have changed. But yeah, they're great people.

Melanie Avalon: That is super amazing. I remember when I released my book, that was one of the first press-related articles I got for it. I was so excited. I was like, mindbodygreen That's amazing. You also are the owner of the Moday Center and that's in Virginia, where you are now.

Heather Moday: Yeah. Well, it's funny, I've been through of a little bit of change. I was in Philadelphia for many years, and I actually had a brick-and-mortar office there. And then during COVID when things shut down, I went online for a while, doing TeleMed mostly. For personal reasons, I moved to Virginia and continued just working remotely sort of telemedicine. I just opened up a very small office here. I'm still mostly telemedicine, but hopefully we'll get more of like a 50-50. Yeah, new it's like a whole new thing for me. It's really neat.

Melanie Avalon: A whole new thing in having telemedicine or having the new office?

Heather Moday: Well, just opening up a new office. It's like, starting over again like I did in 2013, 2014.

Melanie Avalon: Wow. Well, congrats on that.

Heather Moday: Thank you. Yeah.

Melanie Avalon: And then obviously the book, The Immunotype Breakthrough: Your Personalized Plan to Balance Your Immune System, Optimise Health and Build Lifelong Resilience. So, so much going on there. But for the listeners, your personal story, I'm super curious. When did you become interested in immune system? Like, did you want to be a doctor growing up? When did the immune system focus come into play?

Heather Moday: Literally, not until I was, well, it's really funny I do tell the story in the book that I didn't want to be a doctor when I was younger, I don't think. I think I want to be a [chuckles] vet because I loved animals, but then I realized that if you love animals, it's really hard to be a vet. But I always loved biology. I was just like a science geek. So, when I went to college, I studied biology and I thought, “Oh, I'll be in, go into, like, oceanography.” You go through all those permutations of what you want to be when you grow up. Post college, I just needed a job, and I lived outside of New York City, so I got a job at Rockefeller University, which if people don't know, it's one of the most amazing, famous research institutions in the whole world. I don't know how many Nobel Prize laureates have worked there and still work there, but I was lucky to fall into this lab.

It's just a lab tech. It turned out that it was run by this really well known, basically he's called a neuroendocrinologist. So, he is the individual, Dr. Bruce McEwen, who actually invented the idea of allostatic stress load. Basically, like the amount that stress-- what stress does to the body instead of like how we balance that and how much we're able to take, etc. His studies were really about cortisol, it’s actually cortisol on the immune system. That was the team that I was on. This was back in the early 90s and so I really didn't have a clue about immunology at all. And so, learned a lot there and actually learned quite a bit about, the response of stress on the body. But even after that, when I went to medical school, you like, have to learn anatomy, and you're in everything else. It wasn't until I was probably a resident and I did internal medicine, which is general medicine, but I knew I wanted to do some fellowship.

And so, I rotated around and did a couple of months doing different things, and I ended up doing an allergy immunology month and just really loved it. That's what I decided to do. It was of a roundabout way. Of course, from there it gets more fascinating when you learn about functional medicine and you start realizing that, wow, your immune system is really affected by so many things in our habits, in our life.

Melanie Avalon: The vet aspect. Yeah. I learned recently, I think they have the highest suicide rate of any profession.

Heather Moday: Yeah, I can't, I mean, I can't watch a commercial without absolutely crying. I don't think I would be able to handle it. Not that humans, it's hard to see humans suffer and die, of course, but I don't know, small animals, large animals, it's just heart wrenching.

Melanie Avalon: Yeah. Secondly, when I read that in the book about studying with him and the allostatic load, I was like, wow, it's like a celebrity because that's like such a concept.

Heather Moday: I just did a summit with Jeffrey Bland, who's amazing, and he knew him. Bruce actually passed a few years ago, but younger people don't really know him, but he was a giant in his field. It's just one of those people who discovered something that went on to just make a huge impact on research.

Melanie Avalon: Yeah. That's incredible. So, another question that relates to both your personal story and just the history of the immune system in general. You talk in the book about the history of our understanding of infectious disease and how it's evolved and how we view the immune system. It's really shocking in a way to think about how we had just no idea for so long about so many things. [chuckles] So, I'm curious. The evolution of the immune system just in general in history would have been the biggest paradigm shifts or insights that have happened and also just in your time that you've been practicing. Has the view changed a lot since when you started to where you are now?

Heather Moday: Oh, yeah, we've like 10Xed or 100Xed since probably like the mid, I don't know, say like mid 1900s. You can go back if you really dig all the way back, they had an understanding, or not like a real understanding, but you could even go back to the 1500s. They didn't know what they were doing. But they knew that if they gave little bits of infections or of something to someone with say, smallpox, that they might not get sick. But they didn't really understand it. I would say that the real understanding, there's crossover between infectious disease and immunology, and there are really two sciences, but I would say probably a lot of people point to Edward Jenner.

Edward Jenner, this was back in the late 1700s. He's the one who took cowpox. He took stuff from, like, cowpox pustules and gave it to people. So, they didn't get smallpox because smallpox was for hundreds of years a scourge on the earth. He discovered a bunch of other things, too. Some people would say, like, “Oh, that would be like the first vaccine.” Then, of course, Louis Pasteur in the late 1800s actually did create vaccines for cholera and rabies and a couple of other things. He discovered so many different things. I think I mentioned the book, a Russian, a lot of people say he's like the beginning immunologist, and his name is Élie Metchnikoff, and he discovered, he realized that there were cells that could engulf other cells, so phagocytes. There's a bunch of cells that we call phagocytes, which engulfed bacteria and damaged cells and cancer cells, etc. He was a big-- he learned a lot about-- he taught us a lot about the innate immune system.

It goes on and on through the years. Paul Ehrlich is another one. The vaccines really took off in the early 20th century, we didn't have a vaccine program because we didn't really understand, we didn't have the technology or anything like that. We didn't really have a vaccine program till the 1950s with polio. It's really the big one. But I would say since then with technology, because there's so much of the stuff you can't see. You can't really discover cytokines and things like that. You can't really see them. You can see cells with microscopes. There's so much that I would say really took off after the 1960s, 1970s, because of the technology that we have. So, it's fairly new.

Melanie Avalon: Yeah, no, it's so fascinating. Do you know with the people in the early experiments, like with the cowpox and stuff? I don't know if this, but do you know if they did that with the understanding of what they were doing? Like, did they realize that they were giving the body exposure to a small amount of it or did they think it was killing the infection?

Heather Moday: I don't think they thought it was killing the infection. I really do think that it was like that idea of almost like a homeopathic type of idea, like, we're going to give you a little bit and your body's going to somehow learn from this. No, I don't think they understood the science really at all. There were primitive microscopes back then, of course, but so much was just, people really thought outside of the box. They were very creative. I've never read the works of Edward Jenner. I would love to know what was going on in his head. They didn't have the information we have now in terms of looking inside of cells.

Melanie Avalon: It's so fascinating. I've actually had this question for a long time. We hear about all of these awful infectious diseases and I guess, COVID aside, but historical things that were immunized, we have vaccines for today. Did some of these just die out naturally? Or are we literally just immunized to everything that there could be? Also, is it like when we maybe this will be a better question after we've talked more about the immune system, but when we do have immunity to something. For example, is it that we've learned how to fight it or have we just changed the locks on the doors so things can't get in the first place? I'm just really curious about how we're protected against all of these different diseases.

Heather Moday: Well, part of it is if you think back, say you go back 200 years or so 200, 300 years. One thing is you have to understand that we didn't have sanitation the way that we have now. [laughs] So, that's a huge barrier for getting infectious disease because a lot of the things that we get aren't, yes, respiratory, but a lot of what are called fecal-oral transmission, which sounds really gross, but it's true. Basically, that we transmit bacteria and viruses through poop, basically, which gets in our hands. This is how, even now, young parents will tell you, like, “Oh, you get adenovirus,” or you get I'm sorry, not adenovirus, rotavirus. Or if you go on like a cruise ship and you get some of those viruses, those are fecal oral, polio's is fecal oral. There're many, many infections that are that. So, back in the day, we didn't have sanitized water, they were open sewage systems.

That's like a huge barrier right there that once we got modern sanitation, so weren't eating, like, poop all the time, which is big. Also the thing is, people were like, “Oh, you need to wash your hands.” Back before I can't remember exactly, but say it wasn't until probably like the early 1800s or so that surgeons actually wore gloves and washed their hands and things like that. That's why so many women died in childbirth and soldiers died on the field. We just didn't even know the basics of antiseptic stuff. So that's one big thing. The other thing is, if you did get an infection, we had no way to really treat people. Obviously, we didn't have antibiotics, we didn't have supportive care, like if someone got pneumonia and needed to be on, a respirator. There're so many things that if you did get sick, you often would have a very bad outcome.

So, there's that. In terms of, yes, there are some-- viruses die out all the time. They come in and out of the world. We see that all the time, even just now. Like, we hear of like, “Oh, there's an Ebola breakout.” Like, Ebola has probably been around for thousands of years, but it stays around in these animal vectors that I should say vector, but animal populations. It pops out and comes into the human population for a couple of months, and then it goes back in and then it goes away. And viruses are always mutating and changing. I mean, bacteria are pretty stable, they don't change too much generally. Let's just say we've eradicated certain things like smallpox, but we still see there's outbreaks of all sorts of things like, we just had an issue with polio on Long Island, and you'll still see, obviously, measles outbreaks and things like that.

So, they're here. I think part of it is modern medical care, vaccines, sanitation, and maybe stronger immune systems too, because we have better nutrition.

Melanie Avalon: One of my big things in life is gratitude, and I should probably be more grateful thinking about how wonderful it is to live now and not then, because I think we don't appreciate how disgusting [laughs] life could have been.

Heather Moday: Great stories about how London stunk. I moved here from Philadelphia, and outside of Philadelphia, there are these homes that are up. It's really not far. I mean, it probably takes 30 minutes to walk or 45 minutes to walk, but they built houses up in the park because of yellow fever and dysentery, like the sewage and the rats and all this kind of stuff, because cities were stinky and gross.

Melanie Avalon: Growing up, I used to read craft books. I don't know if you've heard of them. They had these, like, science books for kids and they were really funny, but they were, like, really deep. I have this memory of this one page where it was like, how did people walk around in the 1800s and it was like very carefully. It had a person not stepping in basically the feces. It was like saying that they were just on the streets. I was like, “Okay.” But in any case, so the actual immune system itself, your book is so comprehensive because I think the immune system is so vague to people. It's ironic because it's so well known. Everybody knows about the immune system and they want to support the immune system and they're all about the immune system. But I don't know if we actually-- most people don't really know what it actually is. What is it and where is it?

Heather Moday: Yeah, it's everywhere. I think that's why it's confusing because you can't really put your finger on it. It doesn't exist in one place. It's really like a universe or system. We call it a system, obviously, but it's made up of distinct parts, but they're always moving around. So, there's many different cells. I don't even talk about all the cells that are part of the immune system. You break it down into the basics because it's not necessary for people to know all of that unless you want to go back and study immunology. There're lots of different players, lots of different cells. They communicate with chemical messengers, which are proteins that are created in these cells and that they basically tell other cells what to do. There are areas where they hang out.

For example, we have lymph nodes. Most people understand that. We have other immune organs like the spleen, the thymus, a bunch-- a collection of like our tonsils, actually our lymph nodes. We have really a whole chain of lymph nodes throughout the whole body, but in a very large congregation outside of our intestinal tract, where it's such a large collection of these lymphatic or lymph tissue that people often say it's like the center of their immune system. Basically, cells are either hanging out there or they're cruising the lymphatic system or they're going through the bloodstream or sometimes they're just hanging out in tissue. So, it's really everywhere and that's why people are like, “I don't know where it is,” because you can't really point to it.

Melanie Avalon: Is there a central knowledge to the immune system? How does it know what to identify as an issue to deal with?

Heather Moday: I don't know if there's a central knowledge, but depending on let's just say what the insult is. What's the injury? Let's just say there's a difference between if you breathe in a microbe, say something like a streptococcus. So, streptococcus is a bacteria and say you breathe that in or touch it and you swallow it, breathe it in, it's going to be sampled. You're going to have immune cells that are there mostly what are called macrophagocytes or macrophages and things like that. They might sample the bacteria because we have our immune system. This is where that concept of tolerance comes in. We identify outside invaders by patterns on their surface. So, you'll often hear of this like microbial patterns on the surface of different things, whether it's viruses or bacteria, fungi, etc.

These cells which are hanging out there will say, “Okay, I don't know exactly what this is, but I know it's probably not something good because it's not my own tissue.” They've learned over time that this is something that's probably dangerous. So, they sample it, sometimes they might just be able to engulf it and destroy it. Sometimes it has to go up the chain of command and there might be cytokines released. So, you might start to have fever. In the case of injury, you have signals that get sent out from injured tissue that recruit cells to the area. They also secrete cytokines that might do things like increase circulation to the area, so you get blood to the area and fluid and things like that. It's this really incredibly intricate, well-oiled machine that the whole idea is that we should be able to get rid of things quietly and quickly and sometimes without even our knowledge, because we're constantly being exposed to things that might be potentially harmful to us, like on a daily basis. You would never know because your immune system does it so that you don't feel it.

Melanie Avalon: You talk about in the book about how this is ongoing all the time. Like you just said a lot of times, I guess, "Should or could be going just under the radar." Is it always, even on a minute level inflammatory when something gets engulfed? Can it deal with something and not even have an intense inflammatory response?

Heather Moday: Oh, yeah, absolutely. A lot of things that we can do ourselves can break down or denature microbes. So, for example, stomach acid is a perfect example of that. God knows we eat all sorts of crazy stuff all the time. Food is not sterile. [laughs] There's always something you're eating, right? You're always going to eat some bacteria or whatever. Saliva actually has enzymes in it. Stomach acid, obviously, is like battery acid. So that can actually kill microbes. Our skin itself is a great barrier against things entering mucus, just in general, nasal sinus mucus, whatever. I mean, think about what we breathe in on a daily basis if we didn't have these barriers and these enzymes and chemicals that just denature things, then we would be constantly sick. And so that's number one. We always consider barriers as part of our innate immune system, very nonspecific. We don't really think about it too much. There are those innate immune cells which, again, they can swallow things, destroy them, and they're not going to set off like a huge inflammatory response unless they start to really get overwhelmed and then things change.

Melanie Avalon: How evolved do you have to be as a species to have an innate and an adaptive immune system? Do some species just have an innate immune system?

Heather Moday: I believe that there are, I don't know, completely mammals. I'm pretty sure all have both but like reptiles I couldn't tell you for sure but yeah, all humans do have an adaptive immune response. So, much much much more complex.

Melanie Avalon: What's the primary purpose difference between the innate and the adaptive?

Heather Moday: I mean they're both extremely important. I guess you can think of the innate immune system as our first line of defense although technically there are some antibodies that are pretty quick acting as well. The innate immune system, most people say it's nonspecific and when I mean by nonspecific is that, they don't have receptors for like a specific thing. For example, when we talk about the adaptive immune system we actually have T cells and B cells that can identify very specifically certain bacteria and viruses and know exactly what to do. Again, the innate immune cells are more like the bouncers. They can identify that there are things that have, again, microbial patterns or we call pathogen-associated molecular patterns or PAMPs that they know. Okay, this is not good. We're going to engulf it, we're going to inject it, we're going to break it down, or we're going to take a piece of it and we're going to take it back to some of our adaptive immune cells and ask them, like, “Hey, what do we need to do with this?”

Do we need to go ahead and go up the chain of command and do something more specific with it? Those are like the two and there's definitely crossover between the two but there are cells that play very important roles on both sides.

Melanie Avalon: So, you mentioned the PAMPs, are things more likely that situation where they have something on them that identifies them as bad or is it more likely that they lack a tag that says that they're the body or is it a combination of both?

Heather Moday: It's a combination of both because we don't and should not, our innate immune system does not attack our own cells, our adaptive does sometimes. [laughs] Basically, it's those molecular patterns that they recognize and attack. They can also recognize cancer cells. That's an important thing because when our own human cancer cells, that is one exception, undergoes transformation so that it looks weird [chuckles]. We do attack those and that's natural killer cells are really important player that does that and they should have a go between but they are a very important part of our innate immune system.

Melanie Avalon: That's really interesting. Autoimmunity issues mostly or only occur with adaptive, not innate?

Heather Moday: Yes. When we think of most autoimmune activity its usually T cell-mediated which means like you can actually have T cells that attack tissue or you can have antibodies created by B cells that are directed against around tissue. That's usually when we see destruction of tissue, that's what's going on.

Melanie Avalon: With the adaptive immune response, and correct me if I'm wrong about any of this, but it sounds like the two big players would be the B cells and the T cells?

Heather Moday: Correct, those are lymphocytes.

Melanie Avalon: Okay, well, I guess before I ask my question, so what is the primary purpose of the B cells and then the primary purpose of the T cells?

Heather Moday: Well, they actually work together. T cells, I mean, they look different. They have a different structure. They have different kinds of receptors and everything like that. There're many different kinds of T cells. We have what are called cytotoxic or killer T cells. They can actually kill on their own. We also have what are called helper T cells and I actually only talk about a few of these in the book because there's more, I think, there're eight different kinds. It's really not necessary to understand all of those. Helper T cells are really, really important, not only to secrete cytokines and everything, but they also activate, they interact with B cells in order to tell them to make antibodies. So, there has to be that T cell, B cell interaction. So, they work together. I guess you can think of and there's also something called regulatory T cells, which are also important.

T cells can specifically go after viruses and helper T cells secrete different forms of cytokines which will activate other cells. So, for example, they can activate cells that I don't really talk about in the book, but things like mast cells, eosinophils, which are involved in allergy per se. They can do a lot of different things. B cells, their main job is to create antibodies or we call immunoglobulins. That type of cell or a plasma cell can go on to create like tons and tons and tons of antibodies. We also have what are called memory B cells. Those will stay around for a long time. We have memory T cells too, but those give us a lot of our ability to have a long-lasting immunity towards different microbes.

Melanie Avalon: Some questions about the B cells. I was researching them more and trying to understand them more and was learning about how they have basically all of these, like thousands of proteins on them. They're just like going around and bump into viruses.

Heather Moday: They do what’s called “class switching.” They can rearrange their genetic, their genes.

Melanie Avalon: This is very confusing to me. Is it just a numbers game? Do they just float around and then just hope that their combination connects with the virus? Like, it seemed very random.

Heather Moday: It is sort of random, but there're so many of them and then what happens is when they do have a receptor that identifies this bacteria, they do what's called clonal expansion. They can basically clone themselves and say, well, all of a sudden you have like thousands and thousands and thousands of these B cells, and then those B cells can make tons of antibodies. When people say, “Oh, I went into the doctor or whatever and I had an increase in my white blood count,” sometimes it's neutrophils, which are the innate immune very important players there, but they'll say, “Oh, my lymphocytes were high.” That's usually your B cells responding to infection.

Melanie Avalon: So, in theory, could there be the possibility of a virus or a pathogen that has some pattern that is not created by our body or is everything going to be covered?

Heather Moday: It's always going to be covered. It may take them a little bit. [chuckles] This is one of the issues with viruses, is that they mutate, they change their DNA, but they also have, as we've learned from COVID and many other viruses, but COVID is a big one. They can evade the immune system in different ways, so they can hide their molecular patterns and stuff. They have ways of evading our immune system. But no, I don't think there's ever been seen for someone who has an intact immune system that over time we wouldn't be able to figure it out.

Melanie Avalon: This is so fascinating. Who knew all of this is going on all the time. Antibodies themselves, I don't think I really understood what antibodies were, because when I hear antibodies and I wonder if other people think this as well, it sounds like attacking. But is it more just a tag? What does it actually do?

Heather Moday: They don't actually really kill things. They do something called- opsonization is the technical term. They coat, they cluster and coat a microbe and tag it for destruction. That can be from usually killer cytotoxic T cells, although other cells can do it too. Mast cells can do it, eosinophils, lots of different other cells but yeah, they are tagged. There're different classes of antibodies and they look different. There's not a ton of them. I think there's only four or technically there's five. I don't think I talk about one of them because it's usually mostly seen in infancy and pregnancy. They look different, they do different things, they are increased by different cytokines, they play different roles. The ones we usually talk about antibodies. We're usually talking about a class called IgG, immunoglobulin G. That's the one that we're talking about, "Oh, so and so has antibodies too," it's usually IgG because that's the one that has a long half-life and floats around and that's protective.

Melanie Avalon: So, is it true that when you do a blood test for the different antibodies that IgM means you have it actively and IgG means you had it?

Heather Moday: No, that's correct. So, IgM is what we create first. This is where you'll see this typically when they talk about something like hepatitis. When someone first gets hepatitis or even something like Epstein-Barr virus or different viruses, you'll see initially an increase in IgM antibodies to whatever part of the virus and then that will wane because like I said we have this class switching and all of a sudden, the B cells will make IgG class antibodies against the same microbe.

Melanie Avalon: Are there endogenous and exogenous antibodies? Like people will talk about monoclonal antibodies with COVID, is that just giving yourself exogenous antibodies?

Heather Moday: Yeah. Usually when people are talking about monoclonal antibodies, they're usually synthetically made. For example, many of the drugs that-- some of the drugs we get for cancer and autoimmune disease and things like that, those are monoclonal antibodies like forms. When we're talking about our own antibodies, they're all endogenous, they're all things that we make because unless you have an immune deficiency, which is rare but some people do, we make all these antibodies all the time.

Melanie Avalon: I just I’m taking moments, just thinking about all of this going on. I was actually reading in another book, it was talking about circadian rhythms in the body and it was saying that the immune system basically has four jobs of surveillance, repair, attack, and cleanup. It was saying that these are not task driven. It was saying that you would think it would be like you get an invader and-- it's like surveilling and then there's the invader and attacks and then it repairs and cleans up. It was saying that its completely circadian rhythm driven so all that's not happening at once and it happens at different times. It was saying that sepsis is actually when all of that happens at the same time, when we get exposed to a pathogen or something. What is the role of circadian or peripheral rhythms? That like you talk about sleep, how stuff happens when we sleep.

Heather Moday: I wouldn't say that it doesn't happen at other times. I would say that routinely it's like if you think about it, if you only cleaned your house or took your garbage out once a month, you'd be in a lot of trouble. [laughs] So you got to do it every day. However, you're still going to be able to attack and do that kind of stuff, repair even at a time of the day that wouldn't be say like normal. The normal routine maintenance work I would say of our immune system is definitely driven pretty significantly by circadian rhythm. But that doesn't mean that it's not happening at other times when we need it. That's why it is so important to have like healthy sleep habits and things like that because our immune system actually is and I write about this is that it's pretty active while we sleep. I actually learned quite a bit when I was doing research in this area, because this is an area, obviously, I knew a little bit about, but I didn't really think about the fact that sleep is a really, really mysterious like for the longest time, we had no idea why humans actually slept.

Why do we sleep half of our lives? Why is it that if you try to sleep deprive people, you can actually kill them? Part of it is that if you think about it, if we had to do all this work of not only like killing microbes and making antibodies and cleaning up our brain and repairing tissue and stuff like that, we have to do that while we are like walking around and moving our muscles, talking, thinking, all that kind of stuff, there's no way it could happen. It's really a downtime for the rest of our body where our immune system can actually be super active. Well, we're not aware of it.

Melanie Avalon: The sleep chapter was fascinating. You're just talking about how when we are sleeping, that's really when immune activity really ramps up. For people who are because we haven't even gotten into the immunotypes yet, but for people who tend to err on the side of a more inflammatory response in their body, is it possible that when they sleep they actually might get more inflamed?

Heather Moday: I don't think they get more inflamed. I think that because I think part of it is that while we're-- we have that inflammatory response early in the evening that's I talk about during that non-REM deep sleep and melatonin is very active and we have a lot of cytokine activity. But the rest of the evening, when cortisol starts to kick up in the early morning hours, we actually resolve inflammation. We want to be able to do the clean up right and then go back to like a nice homeostasis. So, when we are sleep deprived, whether it's frontend, backend, we can have ongoing inflammation because we haven't done a lot of clean up. We have things that lingers, so everyone's had the experience when they're starting to get like a tickle or something like that, but they're like, “Oh, I got to stay up and write a paper, or I've got to do this thing, I've still got to work.” Or they try to go exercise, get to the gym, and then they just get sicker and sicker and sicker because they're skimping on their sleep. Instead of being like, you know what "I feel this coming on. I need to go to bed and get 10 hours of sleep." Because you know how that feels, "You're going to feel better. You're going to actually start to heal because you're giving the space for your immune system to do its work."

Melanie Avalon: It's fascinating. You mentioned I feel like they should integrate this into public policy, the role of, like when people get vaccines and the antibody response that they mount based on their levels of sleep they got.

Heather Moday: They do not say that. I'm like, I don't understand why that's not public policy that it's not or at least not even that's public policy. But it's something that should really be something that when someone comes in for a vaccine, they say, “Okay, well, tonight you need to make sure that you don't go out and party, [laughs] that you need to go home and sleep because your response to this vaccine really hedges a lot on giving your immune system time to actually do the work.” Because it's the immune system that does the work. I mean, the vaccine is there, but your immune system is what gives you the lasting protection.

Melanie Avalon: In the studies is it the sleep directly following the vaccine or directly prior?

Heather Moday: You know what, I think it's actually both. But most importantly is right after, is that evening because you have then gotten whatever it is. If it's a killed vaccine or a live vaccine or mRNA or whatever. It's to help your body, then do the work. So really, I would say after.

Melanie Avalon: That is just really fascinating. That should definitely be more well known. How else do things go awry just in the immune system? Like you're mentioning, talking about T cells, I think a phrase that people have heard a lot, especially in the holistic health world, is Th1 versus Th2 dominant and issues with that. You have a whole chapter on TH cell polarization. What's happening with that?

Heather Moday: Yeah, so it gets a little complex. Like I said, I really only talk about three different kinds of these helper cells. These are all I talked about, cytotoxic or killer T cells. These are what are called helper T cells. They're helper T cells because literally they help B cells make antibodies. But also there are these subtypes that actually secrete different cytokines that they actually go on to activate other immune cells. The idea is that our immune system, when T cells are born, they're called T cells because they're born in the thymus cell, the thymus gland. They go through this whole process when they're born there what we call naive. And naive T cells don't really know what their job is yet. [chuckles] So what happens is they can be polarized into these different subtypes based on what kind of pathogen they come in contact with and then also other cytokines.

So, Th1 cells, basically we think of those as the ones that are very responsive to bacteria, viruses, fungi whatever. They produce a lot of pro-inflammatory cytokines that can recruit other cells. This is, I would say, when you're trying to really fight off an infection, not to say that Th2 cells can't do that either, but that's the overall. And then we have Th2 cells, T helper 2 cells. These are activated also by those things, but to a lesser extent, they are definitely activated by parasites, certain bacteria that actually are inside of cavity. So, think of like a sinus or bladder or actually on the skin and they make different cytokines and they recruit different cells. They stimulate B cells a lot to create something called IgE. IgE is involved with allergies. So, people can understand if they have a lot of allergies, they probably have a little bit of what we call a “Th2 dominance.”

And then I talk about Th17, which is a little bit different. These are relatively new on the scene. These are highly inflammatory. They are important for killing infection. But when they get dysregulated and when we get too many of them, they can definitely cause tissue damage. So, they're thought to be a big player in autoimmune activity.

So, the whole idea of polarization is that, let's say we have in the case of Th17 cells, for example, those can sometimes be triggered by yeast and fungal infections or things like that. We know that certain bacteria, say in the gut, can be instigators for autoimmune disease. If our body is constantly trying to, say, remove specific bacteria from the gut or a fungal infection, these Th17 cells can start to get really overproduced. It's almost like they get in this pattern of like they're turned on all the time. We're creating all these cytokines and we get stuck or polarized in this one pattern.

That's the idea of T cell polarization, it's not like permanent. We can always get out of this. It doesn't mean that you're not making other T cells. These polarization patterns do tend to line up with certain disease processes or what we call disease phenotypes. So, it's pretty interesting.

Melanie Avalon: So, is that largely environmental driven? Like exposure to different things or can people be genetically inclined?

Heather Moday: Oh, definitely there's genetics and it's so confusing because the genetics behind, let's just say allergic disease, you cannot find one gene. There're probably thousands because it does tend to go through families. You can look at a family and say, “Oh, this family has lots of what we call atypia or atopic disease.” And same with autoimmunity. We see autoimmune patterns in families for sure. There is a component to that, environmental factors, gut issues which are obviously very important, play a huge role in both development of allergic disease, but also development of autoimmune disease.

Melanie Avalon: Do you know with allergies why certain things have persisted? Do you think the body would have evolved by now to learn that peanuts are not an issue?

Heather Moday: Yeah, it seems to be very individual. When I was doing training as an allergist, and even in just my early years, this is not that long ago, so early to mid 2000, we were taught and the overwhelming idea was that you did not want to introduce children or infants to certain proteins early on. So, for example, we would tell moms, like, don't eat peanuts. Don't give your children peanuts or shrimp or anything like when they're babies. What we now know is that's actually wrong. [laughs] It's better to actually introduce your children. I never really understood it because I used to think back then like, oh, well, if you go to Africa, now granted, Africa is a totally, totally different environment. There're many things that are different about the environment stimulating the immune system. But, peanuts in many African countries are real staple as are some other things. I feel like why is it that we're having such a problem. [laughs] Actually, now the tide has turned and they actually recommend that children are given these proteins early on to actually make them more tolerant of it.

Melanie Avalon: So, could they make like, [chuckles] I don't know, like an allergy drink that you give your kid when they're young and it just exposes them to everything?

Heather Moday: There's a book that I just received that I'm going to do a little review on. It's called “The Baby and the Biome.”

Melanie Avalon: Oh, I've heard about that.

Heather Moday: Yeah. This woman wrote it based on her experience with this whole thing. She actually created a line of I believe it's powders that you can mix into beverages and food to introduce these proteins and antigens, what we call them early on to almost like desensitize or I don't want to say desensitize because they're not allergic to them yet, but to promote this tolerance of the foods. So, yeah, and they have been working on and still they do oral desensitization on children. It can be very risky, but they do have some of that's done usually in a clinic or hospital-based setting to try to desensitize children to things that they're already allergic to.

Melanie Avalon: Are we ever immediately born already with an IgE? Or is there like a timeline to when that's all developing?

Heather Moday: Yeah, I mean, it is really, really early. Our immune system is actually pretty underdeveloped when were first born, and we get a lot of antibodies from our mother both through the placenta, but also through breastmilk. Then, of course, it starts to evolve. But I would say that there are some cases of children who genetically are born with really, really high levels of IgE. There's actually a genetic disorder, but I would say that's pretty rare. So, yeah, I think there's always an opportunity to intervene.

Melanie Avalon: I think the PR team for that woman reached out to us. I'm going to look for that email because that's so fascinating. You talk about colostrum in the book, and that's something I've experimented with in the past. Is that a case of taking in something that has antibodies in it?

Heather Moday: Yeah. Colostrum can be really helpful also for reconstituting. It has a lot of IgA in it, which is really beneficial for gut health. That's primarily why I use it, because it can be very protective or protecting that gut immune barrier because IgA is, again, it's just another class of immunoglobulin like IgE and IgG, but IgA is 99% tissue bound. So, it doesn't really float around the body and it hangs out and is secreted by lymphocytes on the surface of our mucosal layer, basically our respiratory tract and our digestive tract. IgA is really again, even though it's technically an adaptive immune response, I always think of it as being an important part of innate immunity, too, because it's on that surface.

Melanie Avalon: You mentioned earlier, T cells in the thymus, people can get their thymus removed right?

Heather Moday: So, your thymus, what's interesting about your thymus is most of the time people don't have their thymus removed, but it does shrink as we get older. [laughs] If you looked at a baby or you did an x-ray, you would see this very like a larger shadow in the chest area, and that's the thymus, because it's quite large when we're younger. As we get older, it involutes and becomes smaller. Now, there is one specific disease called myasthenia gravis which is an autoimmune disease, and they can have what's called a thymoma. You can get cancers of the thymus and things like that, but you wouldn't otherwise have it removed unless it was cancerous.

Melanie Avalon: But if you did have it removed, where do the T cells get educated then?

Heather Moday: So different other secondary lymph organs. Things like the spleen, lymph nodes and things like that, bone marrow, yeah. You wouldn't want to be born without a thymus.

Melanie Avalon: So interesting. The immunotypes, so one of the coolest things about your book is, did you come up with these four immunotypes?

Heather Moday: I did, yes.

Melanie Avalon: Very cool. I'm actually really curious, when you were thinking about this, how did you identify these four? Did you think maybe they were more or less what was that process like?

Heather Moday: The biggest thing I struggled with was what I was going to call them, [laughs] because it was like more of a semantics thing. But I did have a sense of more of like the phenotype or the patient behind it or the symptoms or how people present and that kind of thing. And I knew based on some of the T cell polarization that that was connected to, although it's not obviously 100%, but it does play a role.

It was really because people were asking me about whether their immune system was strong or weak or needed to be boosted or this and that, this idea of two-dimensional immune system just didn't resonate at all because it doesn't it's not real. I was like, well, these are the patterns that I see and that most people in terms of having symptoms or disease or whatever, this is how they fall. One was that they are inflamed right-- their inflammation underlies three out of the four immunotypes in terms of being predominant. It looks different and it's because it's different cells and things.

It was mostly people were like when people have heart disease and diabetes or nonautoimmune arthritis, like just this constant low level inflammation, constant destruction of tissue and just causing issues throughout the body that most of us end up having diseases and dying from, like the typical stuff. But to the point that you can walk around and you're not necessarily feeling it. Like you're not like, “Oh, I broke my leg or something, or I'm in so much pain,” but you're like, "I'm a little achy, I've got this or that, or my blood pressure is high." I thought of fiery, but I was like, that's not quite it. Smoldering was more of like, it's like under the radar. If you really looked at it, these people were constantly putting out fires and they're getting symptoms and over time they're having tissue destruction and it's building upon itself and that's causing more activation of our immune system, blah, blah, blah.

That's the smoldering. Now, people with autoimmune disease can start out that way too, but most of the time because with the misguided immunotype, which are the people who have mostly autoimmune activity, again, autoimmune activity is usually triggered by some underlying inflammation. As we know, certain viruses can do this, certain bacteria, just all sorts of things, but instead they develop autoreactive inflammation. They are specifically creating antibodies and creating T cells sometimes that target self-tissue. They have lost tolerance for their own tissue. It's not all of their tissue, it's just maybe one organ, depending on the myriad of autoimmune diseases that you can have. They also tend to have, they can have-- they're tricky because they can have elevations in Th1 cytokines, they can have the Th17 cytokines, which is the most tissue destructive.

And then there's a hyperactive so again, inflammation, but different. These people have allergies. They are responding to something that's generally in the environment that is thought to be relatively benign. Not pathogens, not something that's going to kill them. Like tree pollen, for example, perfect example. Like tree pollen is completely innocuous. It's not going to kill you, it's not a pathogen. But people have very violent reactions to tree pollen. They have very violent reactions to cat dander and even food antigens. So, these people have increases in IgE and eosinophils and mast cells. They get the typical symptoms of runny nose, congestion, anaphylaxis, coughing, so that's the hyperactive.

And then the last is the weak. Weak is really people who are actually having difficulty mounting an appropriate immune response. This could be both an innate problem, an adaptive issue, failure to create appropriate antibodies, and so there's this low and slow and not really very powerful. These people tend to get more infections.

They have a harder time fighting them, they become more recurrent. Those were the three that I see in terms of phenotypes. I just did a deep dive into, okay, so what's going on underneath the surface.

Melanie Avalon: What I really love is, in the book you have a really intense overview of each type and how it manifests, and a quiz for people to see where they fall. You actually have labs for patterns that might pop up and then supplements that can help, and dietary and lifestyle interventions. So, it's just overwhelmingly helpful. I took the quiz, and it was what I thought it was going to be, which is hyperactive. I always feel like I'm just responding to everything. Like my body is just attacking everything and actually that's something that I've wondered for so long, because ever since I became familiar with the concept of inflammation, I think I developed an inflammation phobia. [laughs] I can't even tell you I always have a therapist in my life, and I would have therapist sessions where I'd be like, talking about inflammation, and my therapist would be like, “Melanie, not everything is inflammation.” I'd be like, “But it is.” [laughs] But what's interesting is even like, in my obsession with inflammation and feeling like I'm inflamed, my CRP is always negligible, like zero. Can you have inflammation and have a zero CRP?

Heather Moday: You can. So CRP, C-reactive protein, I would say it's more specific to certain cytokines. If you have elevations in certain cytokines that tends to be what causes CRP to go up, you can see it in someone who has autoimmune disease. You can also see it in people who have-- I've actually seen really high levels in people who have hives, which think about that as allergic, but sometimes with hives, especially chronic urticaria people can have an autoimmune activity or they can have inflammation of their very, very, very small blood vessels. It's not like, "Oh, if you don't have an elevated CRP, you're not inflamed." But I will tell you if we see an elevated CRP, then we know that you are inflamed. So, there's that and I think that most of the time it's because there's certain interleukins that can be elevated, like IL-6 is a big one for CRP.

Melanie Avalon: On a conventional lab test and people will learn this when they read the book and see the different labs that are recommended, but things that are related to the immune system presentation, is it mostly just the WBC and all the blood cells and the CRP, what else would it be?

Heather Moday: Yeah, we unfortunately don't have a lot of standard blood tests to screen people for inflammation. There are some more esoteric labs that are quite expensive, but they do exist. For example, Cyrex Labs is a laboratory that was founded by an immunologist that does a lot of food sensitivity testing, but also really a lot of antibody testing to many, many, many different things. They have like lymphocyte panels and cytokine panels to look for. These are not things that your primary doctor is going to be doing and they're not going to know how to interpret it or even know what to do with it. They're going to be like, “Okay, well, I see this is elevated, but I don't know what to tell you.” CRP is something that almost everybody can order and if it's elevated, well, then it gives you some information.

There're a couple of other ones, something called a sed rate. You can just look at a regular WBC, a CBC, a complete blood count, and you can look at your total white blood cells and they do what's called a differential. You can look at the amount of neutrophils, the amount of lymphocytes just to get a sense of like, “Okay, what's going on there.” Yeah, we don't have a lot of information from standard labs and that.

Melanie Avalon: And that presentation in the CBC, I've done episodes before on like, blood tests and conventional ranges versus ideal ranges. Is it something with the CBC in particular like the neutrophils and the monocytes and lymphocytes where you could have issues but it would still fall within conventional ranges or if things are off, is it pretty much it manifests in that panel?

Heather Moday: I would say that no, it doesn't always manifest. I mean, it's nice to see, but it doesn't always manifest, unfortunately. I mean, if you have something like if you have an acute infection, you're going to go in, you're going to have high lymphocytes or high neutrophils or something. Of course, if you have cancer, [laughs] that's how things like leukemia get diagnosed or lymphomas. You'll see like massive increase because you've got cancer cells that are spewing out all of these cells. For the most part, I order CBCs on everyone and they don't always look so bad. [laughs]

Melanie Avalon: Mine always looks normal. There's been one time where once or twice when it was off because I don't remember being sick at the time, so that was always interesting to me.

Heather Moday: Yeah, it can happen, but again, it's like I always tell people that, “If you're sick, you might see it and that's normal. That means that your immune system is doing its job.”

Melanie Avalon: Yeah, that makes sense. Something really beneficial about knowing your immunotype, especially when COVID first started. Well, I think at first people were like, boost the immune system, but then there's also this debate about the inflammatory response being the problem. Is this something where, the vague concept of boosting your immune system and taking these different supplements or doing whatever you can do? There probably should be two different words because boost kind of indicates upregulating activity, but there should also be a word of, maybe just fortifying your immune system. Would this be a thing where if you know your immunotype, maybe you shouldn't be taking immune boosting supplements?

Heather Moday: Yeah, I mean, I think that sometimes it's harmful, but sometimes it's just not really going to help you that much. The things that we know about, let's just say autoimmune disease, some of these people are already inflamed and maybe that they may not get worse if they take something like elderberry. But that's not really going to help them. We want to do things that downregulate that autoimmune activity, which is going to be different. It's not like, okay, it's bad to take vitamin C or zinc, which are not really things that are boosting so much as just fueling or giving strength to your immune cells, because we need those things. We need those antioxidants. But I would say it comes down more to maybe doing things that increase cytokine activities that we maybe don't need to do for people who are already somewhat inflamed, those people probably need more calming things or redirection I like to say.

Melanie Avalon: That makes sense. Again, I just refer listeners to your book because it's all in there. I will say with the zinc, I made the mistake recently of I wanted to be preventative and I didn't want to get sick because I was traveling, so I was kind of high dosing zinc and then I was getting, immune shots and I overdid it on the zinc and I got so sick. Now I'm like, “Oh, do not take the zinc lightly.” But one other big question for you, men versus women in the immune system, do you find that when it comes to sex that certain sexes more likely are certain types? What role does sex play in people's immune system?

Heather Moday: So, it's a tricky one, but, I I'm a big proponent of, biological sex being very important when it comes to health and medicine in general. It's because regardless of what you think about it physiologically, you're born a certain way, regardless of how you identify. If you're born with two X chromosomes or an X and a Y chromosome, you're going to develop differently. Your hormones are going to be different, your immune system is different. Not radically so but we do see that women have different responses. What's interesting is women do tend to get more autoimmune activity, and it's not just in women who become pregnant. It's not that it has a lot to do with estrogen, but there're distinct sex differences that promote more autoimmune activity in women. What's interesting is there are some autoimmune diseases that are more common in men.

Melanie Avalon: Like which ones?

Heather Moday: The biggest one is something called ankylosing spondylitis. Ankylosing spondylitis is not one that a lot of people have heard of, but what happens is I guess the biggest thing is that their spine becomes stiff and it actually can fuse together. There're some other things too, but that's a big one with men. But men can get other things. They can get Hashimoto's, they can get rheumatoid arthritis. If you look at it, the percentage of women over men is very, very different. So that's a big one. The other thing is there are differences in, obviously longevity that they think have to do with immunosenescence. Researchers looking at that in terms of longevity for women. There're definitely differences between outcomes for different diseases, infectious disease, women tend to actually do a little bit better sometimes. This is like ongoing research. I probably wouldn't even [laughs] give you any real information. But yeah, there's distinct sex differences that we're still figuring out.

Melanie Avalon: So, for people, because they can fall in these different immunotypes and you talk about how they can have overlapping ones and they can change, but just in general, for people who might feel stuck in whatever immune system situation they're in, like, how fast can people make changes? What's the timeline and what's the hope for getting your immune system back to the way it should be?

Heather Moday: Well, again, it depends what you're dealing with. If you've had 15 years of, I don't know, let's just say something like MS or an autoimmune disease that's caused some irreversible tissue damage. It's going to be hard to reverse that because the tissue damage, the scarring, things have changed. However, as we see from many people who have recovered from many different types of diseases, there's always the opportunity for improvement, for decrease in flareups whether you're talking about an autoimmune disease or you're talking about, let's say, allergies, I've seen people change their allergic response by changing their diet quite significantly. Obviously, we see this all the time in people who are inflamed. I've seen people who just have huge elevations in their C-reactive protein and once they are sleeping and reducing their stress and changing their diet, improving their gut health, it goes from 30 to 3 or something like that, and all of a sudden their joints don't hurt anymore, blood pressure goes down, all those things.

It depends on, I guess, the severity of the immune problem. But you can make changes literally in a matter of weeks to months because we're constantly making new immune cells all the time. We're constantly making new T cells and B cells even though we have the memory ones and our innate immune system is always churning out new cells and attacking new things. So, yeah, you can make some big differences pretty quickly.

Melanie Avalon: I just can't thank you enough for your work in your book because it's just such an educational piece, but then it really gives people agency to actually look at what's going on with themselves and then make changes. We didn't even talk about all the supplements and the diet and the sleep and the exercise and everything, but it's all in the book, and it's very comprehensive. So, listeners definitely check it out. The last question that I ask every single guest on this show, and it's just because I realize more and more each day how important mindset is. What is something that you're grateful for?

Heather Moday: Oh, gosh, so many things. [laughs] It's funny, today I was actually driving into a tunnel and there was an accident, and I was really happy that I wasn't in the accident. I would say, on a general scale, I think many people complain a lot about where we live in the United States, and they complain about politicians and people doing horrible things. I really like to think about all the goodness that's going around. I feel very fortunate that I live in a country that, as a woman, I can do a lot more than I could do in other countries, that I'm generally safe. We have generally adequate healthcare, and we have access to healthy food. There're so many people in this world that don't even have a fraction of what we get to enjoy every day. I try to remind myself of that I am very privileged to have that, and so I shouldn't complain about the small things in life really.

Melanie Avalon: I love that answer so much because like you said, people will go on and on about all of the bad things happening and everything, and when people do that, I just like to reframe. Like, there's a lot of good in this world and we have a lot to be grateful for.

Heather Moday: I'm not living in a war-torn country. There's not a missile in my backyard. I'm not wearing a burka. I have clean water to drink. I mean, people don't realize we're very spoiled in what we have access to. So that's what I'm happy for.

Melanie Avalon: I agree so much. Well, thank you so much, Dr. Moday. This was absolutely amazing. I cannot thank you enough for your work. I really encourage listeners to get your book ASAP, take your quiz because you have the quiz online where people can take the quiz.

Heather Moday: Yes, the quiz is on my website, too, so if they go to my website, which is just www.modaycenter.com, you can also access it through my Instagram page under the links by Linktree. Then, of course, it's in the book, but you can take it on the website and get your answers too, and then yeah, definitely get the book. It's out there.

Melanie Avalon: Perfect. Well, we will put links to all of that in the show notes. Are you going to write another book?

Heather Moday: That's the big question. [laughs] It's funny because yeah, last year I was talking to my book agent and she said, “Okay, what's next?” I was like, well, okay, but I'm such a, I don't want to say, like, a perfectionist. Like, I do things perfectly because I do not, but I feel so responsible to make something that is unique and interesting and isn't just a repeat of what a lot of people are talking about. So, yeah, there're a lot of things I'm interested in. I'm trying to see what comes to me that I'm like, “Oh, I can write something that's very interesting and useful that people, when they buy it, they go, oh, I have not heard this information before.” So that's what I'm looking for.

Melanie Avalon: There's so much of the same content over and over, and so it's really exciting to get both a nuanced and a new perspective on something. Your book was 100% that so you accomplished that goal for sure. It's sure you will with your future books as well. Thank you so much for your time. I appreciate this so much. We'll put links to everything in the show notes. This was amazing. Hopefully, we can connect again in the future.

Heather Moday: Absolutely. It was a pleasure.

Melanie Avalon: Thank you so much. Bye.

Heather Moday: Bye.

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